Provider Demographics
NPI:1083893044
Name:LOOMIS, ROBERT LEE JR (IDC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:LOOMIS
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 DAMYIEN ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5169
Mailing Address - Country:US
Mailing Address - Phone:229-869-6272
Mailing Address - Fax:
Practice Address - Street 1:USS KEARSARGE
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09534-1662
Practice Address - Country:US
Practice Address - Phone:757-396-4282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman